Do I have anything to say about substance use/abuse and depression in
the queer community? Oh, yes. Lots.
Substance abuse in the queer community is rampant. But the same can
be said for our society as a whole. We are a nation of people who want
to feel good or avoid feeling bad and we find many ways to do that.
Substance use/abuse is but one. Others include destructive sexual
practices, overspending, overeating, etc. If you look at the names of
12 step programs, you will see just some of the ways we try to feel
good or avoid feeling bad.
As a community, we do have a problem with substance abuse. Are the
figures higher in the queer community when contrasted with the non
queer community? Possibly. As Mark Twain one said, There are lies,
damn lies, and statistics. The figures that indicate there is more
substance abuse within the queer community than within the non queer
community are almost always quoted by individuals with an ax to grind.
No one, seemingly, wants to look at the problem in the country as a
whole or the queer community as a part of the whole.
On the other side of this, the largest group that marches every year
in the Queer Pride parade in San Francisco each June is a group called
Living Clean and Sober. This is a queer group of people who also are
members of various 12 step programs. The week following the parade
each year they have a big annual three day conference in San Francisco.
So, while we have a substance abuse problem (that is similar to the
non queer community), we also have many in the community who are
dedicated to dealing with this problem.
Substance abuse patterns differ within the queer community. Gay men
are more likely to be poly drug/alcohol abusers. Lesbians are more
likely to get into trouble with alcohol alone, though there are enough
individual cases to make such distinctions meaningless. I do not know
what the same statistic for the transgender community would be.
And, there is no one way to deal with substance abuse. It is
estimated that half the pure alcoholics who give up alcohol do it
without the help of a 12 step or other program, they just stop. The
other half appear to take part in various 12 step and other programs to
help them maintain their sobriety. The party drugs that so many gay
men get into, especially methamphetamine (speed, crystal, Tina) are
much more difficult to deal by oneself. There are only a few people I
have ever met who were addicted to speed who managed to stay sober
without help. As I mentioned, the same is not true for pure
alcoholics.
And it continues to amaze me the level of denial that exists among
queer party drug users. They can be using the drugs every weekend for
a couple of years, and occasionally during the week. They might have
lost time at work, or have had a relationship break up over their
substance use, yet they continue to deny they have a problem with it.
The consequences of speed are also more catastrophic. There are many
old alcoholics. There are few old speed users.
Success in recovery, btw, seems to be related to the amount of time a
person is willing to put in. The more a person is willing to do for
themselves, more meetings, more therapy, more support groups, the more
likely it is that the recovery will be successful. In my opinion, the
first year of the recovery process is the most critical and I advise
people to look upon that first year as a time when they are in recovery
full time. All available efforts should be directed toward their
recovery program.
Regarding depression - yes, it appears to be higher in the queer
community. There are probably many causes of depression. The drug
companies would like people to believe that it is all because of a
chemical imbalance and that can be cured by a pill. Antidepressants do
change mood, but like everything lese, at a price. There are many
nasty side effects of antidepressants.
Your assumption that the increased level of depression is it probably
related to the anti-queer sentiment in this country, and what queer
people must endure (a lot of loss related to family and the culture as
a whole), is probably right on. But depression is a major problem in
this country for a lot of people, just as substance abuse is also a
national problem.

Your comments on these issues raise in my mind a more general one: health
care in general. My thinking also harkens back a bit to fellow who had the
strange encounter with the insurance lady. One major issue in queer
communities is how well we access and utilize health care -- and for the
moment I'm including psychotherapy in that. Certainly lesbians are often
overlooked in terms of screening for STDs and even more general
gynocological conditions on account of not being asked the right questions
or being too afraid, ashamed or awkward feeling to speak up about our health
concerns. As the insurance lady so poignantly illustrates, it often simply
does not occur to some providers that queer folks might have special
concerns and considerations.
You've talked a lot about queer affirmative therapy. Building on that,
perahps, what thoughts do you have about how queer persons can identify and
advocate for their own unique needs when seeking psychotherapy?

Cindy - You have brought up an interesting point when you ask "how
queer persons can identify and advocate for their own unique needs when
seeking psychotherapy?"
The irony is that the time when a person is seeking psychotherapy is
often the time when that person is less likely to be able to advocate
for their own needs. People often seek psychotherapy when they are in
crisis, and while in a crisis clear thought is sometimes difficult. It
is a lot easier to think clearly and advocate for one's needs when one
is not in a crisis.
If there is one thme that stands out to me in advocating for one's own
unique needs, it is to request/demand that one be treated with
respect. Because queer people have been taught to feel ashamed of who
they are, many queer people have the notion being queer means that they
have done/are doing something that is bad. This is often on a deep
and suble level. And it is difficult to advocate for oneself, to demand
that one be treated with respect, if one feels bad or ashamed of
themself.
So my message would be this. Not only is it not bad to be queer, it
is not bad to have problems, even severe ones. No one asks to have
problems in their lives. No one wants to live a life of unhappiness.
There are many reasons why that happens, but it is not because the
person in such a situation is bad. Queer people, and queer people in
pain, unhappy with their life, or with severe problems deserve total
respect for who they are and what they need in health care.

You've been in practice for a number of years now and I'm curious about any
trends or changes you seen in your practice from the time you began until
now. Are you seeing more of some kinds of problems and less of others? Mor
of some types of clients than others?

Could you outline ways in which a queer person might request/demand that
they be treated with respect? Reclaiming the word queer seems like one way.
Do you advocating fighting every fight that comes along no matter when or
where? Is it enough to remind ourselves that we're not bad people and are
worthy of respect in some cases?

First let me address how my practice has changed over the years. I
began my private practice in 1978, a very different era in San
Francisco. Some issues have remained the same, others have changed.
And please remember I work more with gay men and bisexuals than with
lesbians. I also see some heterosexuals and occasionally someone who is
transgender.
Most of the basic reasons people have sought psychotherapy services
have remained the same. Times change but basic personality issues do
not. So people seek psychotherapy because they are feeling anxious,
depressed, having relationship problems, wanting to be in a
relationship, or just wanting to talk. But in other ways, the reasons
people have sought psychotherapy have changed.
The biggest changes relate to HIV over the past 20 year. It began
with people being scared. There was a lot that was unknown and in those
first few years, it was about the impact of being scared. This
quickly changed to grief; the entire queer community was hit with
massive unresolved grief that could not be dealt with because new grief
was always being added as people continued to die. The unresolved
grief continues today. And people are continuing to die from HIV.
While not in the numbers that was true just a few years ago, but still
enough that many of my clients are directly touched.
The really new content issues, particularly for gay men relate to
dating and creating multigenerational families. The dating issue is
vexing to a number of gay men. Their self image and self esteem come
out in dating in ways they never had to deal with in the old days.
While they want to date, they find an internal resistance that they use
therapy to deal wtih.
Now to the other question as to how to request/demand respect. Here
are some thoughts I have on the question. (I would love to hear other
peoples take on this). Two issues overlap here. One is recognizing
ones feelings, and the other is asserting them. And this is where I
believe gender differences come into account. Men are bad at
recognizing their feelings. Men are reactive, they will say or do
something when they are disrespected, but it will often be an angry
reaction. Women, I believe are much more aware of their feelings of
being disrespected, but have been socially conditioned to not respond,
particularly when the disrespect is coming from a men or a woman in
authority.
I would suggest men need to slow down and recognize their feelings
when they are happening so they can respond in a more constructive
manner, while women need to learn to respond more assertively.
And one last comment. I do not believe in fighting every battle. I
beleive in picking the battles that make the most sense. To fight
every battle would get us sidetracked into less important issues, and
cause us to burn out.

Destructive sexual practices is a hot button issue. Because queer
people have been defined by the mainstream by our sexuality and
condemned for it, there are many people in the queer community who are
reluctant to speak to this issue. In my opinion, virtually anything
can be used or abused. Sexual practices can be life affirming, or
destructive. Often it is a mixture of both, which makes it difficult.
What are destructive sexual practices? First the obvious ones. Non
consensual sexuality. Putting aside things like rape, which is an act
of violence rather than an act of sexuality, sexual practices that
involve people in a non consensual way, such as exhibitionism (i.e.,
exposing oneself or masturbating in places designed to shock others) is
clearly a destructive sexual practice. Like rape, these are actually
aggressive acts that use sexuality to promote the aggression. But they
are listed under sexual acts, so Ill leave that there.
Perhaps more to the point is when activities that in and of themselves
are not destructive, i.e, going to a sex club, but can in the context
of one persons life may be destructive. Take two people. Both leave
work and go to a sex club on a daily basis. For the first person, it
is a healthy expression of his sexuality. He makes contact with
others, enjoys his time there, gets sexual satisfaction, takes the
proper health precautions given the state of his health, and is able to
integrate this into his life in a way that doesnt interfere with
anything else.
Now for the second person. He also goes to the sex club on a daily
basis. But he also tells his boyfriend that he is working late. He
misses appointments because he loses track of the time and is in
trouble with friends/coworkers/family members because of this. He
finds himself continually picking up various sexually transmitted
diseases even though he doesnt want this to happen. He tells himself
he is going to change but continues with the same pattern. For this
person, when his dick gets hard, his brain goes soft. His sexual
practices are having a negative effect on his life. They are
destroying something that he doesnt want destroyed. This could be his
relationship, his job, his health, or his self esteem.
When there is a pattern of sexuality that results in failure to
fulfill major role obligations at work, school or home, or is
physically hazardous, or is causing legal problems, then I would
suggest those sexual activities are destructive.

interesting topic - especially the point that the same experience can be
healthy for one person and not healthy for another person. Do you think that
is also true when say a teen has sex with someone much older - that
sometimes for some teens that could be a healthy sexual experience and for
others it may not be?
do you come across that at all in yr practice?

Determining the definition of "destructive" on an inidividual basis is
sophisticated and logical, though I'm sure some folks would find it
maddeningly fuzzy to not have one rule for everyone.
I'm thinking that obsessions with anything can be destructive, and threaten
the ability to keep a job, maintain relationships, take care of oneself,
etc. Sex is one of the areas where people can go overboard. In that
way it is more like food disorders than drugs or video games. Going cold
turkey is problematic. You have to have some sexuality after all, just
as you have to have some caloric intake.
The obsession factor may be why it is inevitable that individuals, healers
and societies all have pressures to draw lines of what is OK and what
is too much, too dangerous or too different. I wonder if the existence of
all the dumb taboos about sex and sexuality has a certain inevitability,
since culture is in part a search for simple consensus rules to make
living easier.
I hadn't thought of it before, but recent posts point out why
sex and gender "rules" have been made in societies, and why it is now
largely the work of individuals to identify where the beginnings of
dangerous sexual patterns are. Except for areas of consent, of course.
Interesting territory.

I believe one of the major problems we have as a society is wanting
things to be black and white, a one size fits all mentality where
things are clear and unequivocal. Rarely is that the case in my
experience. Things like sexual activity must be understood in context.
There are some things that seem to be black and white, but arent.
Take murder. Most people would say murder is wrong, and that is a no
brainer. Murder is wrong. But then there is the old response, what if
a German citizen during World War II you had an opportunity to murder
Hitler. Would that have been wrong? Some would argue that in that
case the murder would be justified.
So, if murder can sometimes be seen a justified, how can that not
possibly be true for sexual activities. The example you cite, a
teenager having sex with someone much older, is a hot button issue in
our society. People would like to believe that it is always wrong.
Period. I dont agree. I believe it is necessary to understand that
sexual relationship in context.
Many clients, mostly gay men, have over the years told me of sexual
experiences with men much older when they were teenagers that they
continue to look upon as positive experiences. And I do not believe
these are cases of denial. Often the teenager was the aggressor in
these situations. Sometimes that was not the case but the experience
was still positive. And in other cases, it was a negative experience.
Age of consent is also a legal issue but that has to be looked upon in
a legal context. The legal age for giving consent differs in
different states and countries. I believe it was once legal in some
states for a 14 year old to be able to give consent. Most states the
legal age is now between 16-18. Some European countries have a minimum
age, but also have a provision that if the two people are near each
others age and one is above the legal age and the other is beneath the
legal age it is not against the law if they are within several years
of each others age.
I would also like to add a comment to mayas post concerning my
comments as to when sexual activity is destructive. He states Which
is my understanding of the legal definition of addiction. It is not
the legal definition, but a psychological definition. It is quite
close to the psychological definition of when something is an addiction
or a destructive compulsion.

I would also toss in the comment that not all "sexually destructive
practices" are necessarily "addiction"-like or compulsive. Sex is one of
several domains in our life that bring together different aspects of
ourselves and our relationships. It's one place where we can integrate
mind, body, heart and spirit in some really incredible ways. It's also a
place where sometimes some pretty deep, perhaps even primitive, issues can
get enacted. It's resplendent in its opportunities for incredible joy and
incredible pain.

Gails posts slipped in before my last post. And I agree with much of
what Gail said. Obsessions are generally destructive, although society
sometimes benefits while the person loses. The composer who is
obsessed with creating beautiful music might have a miserable life as a
result, but those listening to the music might simply be enjoying what
they are listening to without knowing the personal cost to the
composer.
I do believe we all have destructive tendencies, and for a lot of
reasons. Those tendencies need to be controlled for the most part.
Some of those destructive tendencies can be sexual. Laws are passed to
set limits. But sometimes the laws are bad laws. Laws against
homosexuality are an example. Sometimes they are good laws. I believe
as a civilized society we need limits; in some ways that goes to the
heart of what being civilized means. But sometimes even good laws have
exceptions.

Regarding Cindy's comments in post #64 "It's one place where we can
integrate mind, body, heart and spirit in some really incredible ways.
It's also a place where sometimes some pretty deep, perhaps even
primitive, issues can get enacted. It's resplendent in its
opportunities for incredible joy and incredible pain."
I wholehearted agree! Sex is adult play. Play is important for
children to be able to integrate and work through many of their issues,
as well as being fun. It is no different for adults. We all need to
play, and sexuality is one form of adult play. In fact, I am going to
go off line now for some adult play. Cya later.

> It is not the legal definition, but a psychological definition.
Perhaps both, certainly the legal I beg to differ. I was recently
working on a case of a man who committed a crime while on speed. He
was defending himself and protested the descriptions of himself as an
addict as he felt his use of the drug was moderate and recreational,
nothing more. The case interested me because I have so many gay
friends questioning their practices with this party drug. They are all
"negotiating" with the drug. While reading the trial transcripts on
this case, there was extensive testimony by doctors on addictive
behavior that was entered into the legal record to provide a legal
definition of addiction. Much of it tracked with your "psychological"
definition. The point being, as with the term "homosexual", the
medico-legal definitions are set in place for specific reasons and I
think it's important to know why they are set in place and how they are
being applied. I appreciate that your standard of "normalcy" is
flexible, which is the only sane response (IMHO) to such "hot button"
issues. I wanted to make sure you were flexible in your approach and
not judgmental.

I love good play.
Before I heard of yr bk I suggested people look at this website-
http://www.bannon.com/kap/
Are you familiar with that website and think it is a good resource - as well
as yr bk?
Thanks for your answer about looking at the sex in context - it is something
I feel strongly about.

Debbie - I am quite aware of the website you mention. For others, the
"kap" in the url stands for Kink Aware Professionals. This is a free
referral site for those who want to find doctors, lawyers, accountants,
psychotherapists, etc. who are kink aware and kink affirmative. I
have been listed on that web site for a number of years, almost since
Race Bannon started it.
In the book I also talk about finding a therapist who is
kink-affirmative. For those clients who are into sexual kink, it is
absolutely necessary that the therapist is both kink aware and kink
affirmative. Sexual kink is still pathologized in a number of ways by
the mental health profession. All this is as valid as when they
pathologized homosexuality. But it is still on the books and is
considered a "mental illness" by those who subscribe to a medical model
of mental functioning and who also consider kink to be indicative of
mental illness.
maya - thanks for those insigts into how psychological diagnoses
become legal definitions.

interesting about kink awareness.
michael, where is the line drawn with kink though - or is it forever
relative? when is kink just kink and when is it self-destruction -- if it
is ever self-destruction? i think our kinks say a lot about us, if we look
at them in a nonjudgmental way, which is what i'm guessing kink-affirmative
means.

that's an interesting thought - that our kink says a lot about us. like
queer says a lot about us? ina way it does, but in another way it doesn't.
Just because someone is gay it doesn't actually say anything about thier
personality or their voting pattern or anything that you can pin down in
that way. I feel like kink says something about me the way brown eyes says
something about me, because for me, it is just the way I was born.

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